Updates in diagnosing polycystic ovary syndrome-related infertility

ABSTRACT

Introduction

Polycystic ovary syndrome (PCOS) is a condition that affects approximately 13% of reproductive age women and is characterized by androgen excess, menstrual irregularity and altered ovarian morphology. PCOS presents a complex etiology and pathophysiology, which still requires a detailed investigation of biochemical signatures to identify the molecules and mechanisms that govern it.

Areas Covered

This narrative review summarizes the main molecular alterations found in the ovarian follicular fluid, endometrium and placenta of women with PCOS, and the genotypes potentially associated with the outcome of infertility treatments in PCOS.

Expert Opinion

PCOS is associated with multiple alterations in growth factors, sex steroid hormones, reactive oxygen species, proinflammatory cytokines and adipokines, which contribute to follicle arrest/ anovulation or suboptimal corpus luteum function, and ultimately to menstrual irregularity and hyperandrogenic symptoms. A panel of PCOS biomarkers should include, besides ovarian products, markers of adipose tissue function, insulin resistance, vascular health, and low-grade chronic inflammation. The effects of ovarian stimulation drugs on infertile women with PCOS are likely to be modified by genetic factors, but the available evidence is heterogeneous; therefore, future studies should evaluate standard treatments and pre-specified outcomes of interest to provide more conclusive answers.

KEYWORDS:

• PCOS
• infertility
• diagnosis
• follicular fluid
• biomarker
• polymorphism

Article highlights

• PCOS is the most common endocrine disease in women of reproductive age and is a leading cause of anovulatory infertility.

• Disrupted ovarian steroidogenesis with excess androgen production is a central mechanism of PCOS.

• Paracrine and autocrine factors are abnormally produced in PCOS by ovarian cells and released into the follicular fluid.

• The endometrium of women with PCOS can be affected by excess of androgens and insulin, and by the constant estrogen stimulation without progesterone modulation.

• The effects of ovarian stimulation drugs on infertile women with PCOS are likely to be modified by genetic factors.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers Disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.